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LIQUID WASTE PERMIT <br /> SAN JOAQUIN COUNTY FULIC HEALTH SERVICES ENVIRONMENTAL HEALTH DIVISION <br /> G 3M E.WEBEIL AVE 1'°'FLOUR STO:KTON.CA 95}02120)NiVJ130 <br /> V 1 NON.—REEFFUN�DABL�R�PE�R//MIT EXPIRES I YEAR FROM DATE ISNUED <br /> JOB ADDR/.S9 NVT, APPI '1 //_O/i PARCEL SITE:_!5�/y� <br /> COyIZIP_7 Y����� BUILDING PERMFI'N <br /> OIYNERNAMF. <br /> CITY2IP PHONE NUMBER Ppb <br /> CONTRACTOR ADDRESS <br /> CITY21Pf7R��!(��/� PHONE NUMBERf� , <br /> GEOGRAPHICAL INFORMATION: COORDINATES:%�_. v_. .. TOWNSHIP RANGE SECTION_ <br /> '1'YPEOFSEPTICWORK: INSTALLATION WILL SERVE: NUMBER OF LIVING UNITS:—,� <br /> QI NEWINSTALLATION /' REMiOENCE NUMBER OF BEDROOMS: -� <br /> ❑ REPAIRIADUITION ❑ COMMERCIAL <br /> ❑ DESTRUCTION ❑ OTHER NUMBEROFEMPLOVERS: <br /> ❑ ENGINEEREDIALTERNATIVE <br /> CHARACTER OF SOILTO DEPTH OF 3':-AA=�1. PIT/SUMP SOIL CHARACTER: WATER TABLE DEPTH:_ <br /> ❑ PERCTEST(S) HOW MANY APPLICATION <br /> ❑ REPTICTAIK TYPEIMF (j,(} (/.)•[� CAPACITY #OFCOMPARTMEMS P <br /> ❑ GREASETRAP TYPE/MFG CAPACITY _ AOFCOMPARTMENTS_ <br /> ❑ PK=PLANT DISTANCETONEARESIC WELT._ FOUNDATION PROPERTY LINE - <br /> ❑ LIFT STATION SIZE iYPEOFPUMP_ SAND OIL BRA RATOR(ENCWSE D SYSD'A1W_ - <br /> LEACN LMEKOFLINES: LENGTHOFLINFS_FF,C10rvCytO <br /> uPinwRi; WELL PoVGP <br /> NDATION �ERTYLINE�� <br /> INWLITRATOR H.SMBEIVE <br /> ❑ FILTER BED WIDTH_ LENGTH_ DEPTHolnirvei Mrvw[R: WELL_ FOUNDATION_ PROPERTY LINE_ P^ <br /> ❑ <br /> MOUNDED WmTX_ LENGTH_ DEPT(__ wsTin.Y.WEE n.: WELL_ POUNOATION_ PEMID'V LIRE_ V <br /> ❑ EUMPE WINTX_ TEYGM_ DEPTH__ ADAXvroMRAKI. WELL_ FOUNDATION_` PROPERTY LINE_ 11. <br /> ❑ DISPOSM.PONDS WIMII LENGTX_ OF.PIN_ ouuncc TpNdRE6 WELL MUNDATION_ PROPERTY LINE__ 11l <br /> ❑ SEEPAGE PITR F DIAMETER— DEPTH DgANCIYGNUR6l: WELL FOVHDATION� PROPERTY LINE <br /> I HEREBYCP.RTIFY THAII HAVE PREPAREDTHIS APPLICATION AND THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUTA'COUNTY ORDINANCCR WATE LAWS <br /> AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. <br /> IGRFID: 111M1HOUR ADVANCENOTICE REQUIRED FOR INSPECTIONS-PLEASECA �./ <br /> S -- TITLE: ys DATE: <br /> �r <br /> I I 1 <br /> � I I <br /> - r It fill <br /> ti <br /> r <br /> r— <br /> �- <br /> a It — — 1 <br /> N4 0 <br /> 1w ON.. <br /> � I <br /> i— i <br /> PJARTMS-TN-T EO LY I _�rI <br /> APNCATIONACCEPTPDBY: � _ STPCTL� ' - <br /> ATIO-NF. LOLA }/1 — <br /> ' <br /> INSPERF08Y3 V V+ ppTEyJ"1/ rp1 TTFlNAYESDATE <br /> PERMX "ID-2 INSPECTOR(KPu iw. Q I1. V y <br /> COMMENT$: '.' <br /> PECCNE SCIMTO RANn1AE 1.X00 N pFCfil4E0 ppTP PERMITRLR VKC R[DRESry INVOICE! SEMICIM <br /> �r /r7 z� 707 BY <br /> o oos <br /> REI _. <br />